Knee Capsule Strain

Posterior Knee Capsule Strain In A Football
Player Preparing For The Pro-Combine

A 23-year-old black male elite football player
running back was preparing for the Pro-Combine through strength and
conditioning. The medical and surgical histories were benign and the
patient was without pain, discomfort or knee pain prior to a broad jumping
task. The player performed a 10-foot broad jump landing favoring his left
knee in a hyperflexed position with his buttocks almost touching the
ground.

In order to recover from the jump, the patient
utilized his left leg to extend himself and in the process externally
rotated his knee as he fell forward. The patient experienced immediate
discomfort in the posterior lateral aspect of the knee. He avoided any
further broad jumping but participated in a generalized conditioning
program that day. In the evening, the patient had increasing pain and
minimal swelling the posterior area behind the knee.

In addition he had difficulty extending his knee to
horizontal as well as externally rotating his knee. In the morning, the
patient awoke with difficulty extending the knee due to tightness,
stiffness and pain with extension and external rotation of the knee.

On examination, the primary finding was tenderness to
deep palpation along the midline of the distal femur in between the medial
and lateral condyles. The tenderness extended a distance of three inches
from midline of the distal femur toward the proximal tibia.

Additional pain on palpation was noted posteriorly in
the distal femur adjacent to the lateral condyle. There was no notable
joint swelling. The tests for meniscus as well as the anterior and
posterior cruciate were negative for any significant laxity or tears.

The patient had full range of motion but pain in the
last ten degrees of knee extension. With the knee flexed, external
rotation reproduced the pain; however, internal rotation caused only mid
soreness. There was no Baker’s cyst noted posteriorly.

The assessment was a posterior capsule strain that
had the following functional limitations:

1. Resistance to full extension

2. Resistance against external rotation of the knee
with pain along the oblique popliteal ligament.

The primary diagnosis for this individual was a
posterior meniscofemoral ligament strain and a very minor posterior
cruciate ligament strain.

The most common mechanism of injury was
hyperextension combined with external rotation of the knee. This
presentation seems to be classic for a superficial posterior capsule
ligament sprain without derangement of any internal structures within the
knee joint proper.

Patient was instructed to participate in active range
of motion, stretching, anti-inflammatories, cold, ice and rest of three
days prior to returning to activities of hyperextension and external
rotation of the knee. The patient recovered through the conservative
treatment and had no further sequela to the problem.

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